Closed chest coronary bypass

Abstract

A method and apparatus for performing coronary artery bypass surgery establishes a channel leading directly from a chamber of a heart into a coronary artery. The coronary artery bypass procedure may be performed with or without cardiopulmonary bypass.

Description

1. Field of the InventionThe present invention relates generally to a method and apparatus for performing a coronary artery bypass procedure. More particularly, the present invention performs a coronary artery bypass utilizing a number of approaches including an open-chest approach (with and without cardiopulmonary bypass), a closed-chest approach under direct viewing and / or indirect thoracoscopic viewing (with and without cardiopulmonary bypass), and an internal approach through catheterization of the heart and a coronary arterial vasculature without direct or indirect viewing (with and without cardiopulmonary bypass).2. Description of the Prior ArtCoronary artery disease is the leading cause of premature death in industrialized societies. But the mortality statistics tell only a portion of the story; many who survive face prolonged suffering and disability.Arteriosclerosis is "a group of diseases characterized by thickening and loss of elasticity of arterial walls." DORLAND'S ILLU...

AI Technical Summary

Benefits of technology

The present invention is particularly useful for coronary artery bypass procedures in a patient suffering from obstructive coronary artery disease. The methods can be performed while the patient is anesthetized. Anesthesia may be, but is not limited to, general anesthesia. The present permits an array of procedures of varying invasiveness. As in other procedures, the level of anesthesia necessary is expected to vary directly with the invasiveness of the surgery. The present invention, because it minimizes normal tissue damage, is especially useful for coronary artery bypassing in a patient who, because of other medical problems such as chronic respiratory failure, must be maintained at a higher level of consciousness than that usually realized during standard general anesthesia. In such a patient, a less invasive approach may be chosen. As in any major surgical procedure, the patient's heart and respiratory rates, peripheral oxygenation, urinary output, and other bodily functions may be monitored. During some or all of the bypass, cardiac contractions can be slowed, or stopped, to both improve visualization of the coronary vasculature, and to reduce the oxygen requirements of cardiac muscle. An intra-esophageal probe or probes, or other appropriately-placed probe or probes to monitor the cardiac cycle, and to trigger power to the intraventricular laser when utilized, may be advantageous.

In summary, creating a channel or channels which lead directly from a chamber of the heart into the coronary arterial vasculature should decrease the morbidity and mortality of bypass surgery, should reduce post-surgical recovery time, should decrease coronary artery bypass grafting costs, and should allow the creation of multiple bypass sites to multiple diseased coronary arteries either simultaneously, or at some later point in time. In no way is the procedure limited by the availability and patency of veins or arteries harvested from the bypass patient. In addition, the invention eliminates the risk of aneurysmal dilitation and subsequent functional deterioration of transplanted saphenous veins, as well as the risk of arterial constriction and subsequent functional deterioration of internal thoracic or gastroepiploic arteries, particularly when compared to techniques which result in torsion on transplanted artery.

Problems solved by technology

Coronary artery disease is the leading cause of premature death in industrialized societies.

Early in this century, the treatment for arteriosclerotic heart disease was largely limited to medical measures of symptomatic control.

Angioplasty, and the other above-described techniques (although less invasive than coronary artery bypass grafting) are fraught with a correspondingly greater failure rate due to plaque reformation.

As these alternative techniques are relatively recent innovations, it is too early to tell just how successful they will be in the long term.

However, because re-blockage necessitates the performance of another procedure, there has been renewed interest in the clearly longer-lasting bypass operations.

A major obstacle has been the limited number of vessels that are available to serve as conduits.

However, this technique is fraught with its own inherent hazards, though.

When a single vessel is used to perform multiple bypasses, physical stress (e.g., torsion) on the conduit vessel can result.

Such torsion is particularly detrimental when this vessel is an artery.

Unfortunately, attempts at using vessels from other species (xenografts), or other non-related humans (homografts) has been largely unsuccessful.

Similarly, trials with synthetic alternatives have not been encouraging.

Once these "spare" vessels have been sacrificed, there is little or nothing that modern medicine can offer.

It is unquestionable that new methods, not limited by the availability of such conduit vessels, are needed.

The above-described procedure is highly traumatic.

The most troubling complication, once the immediate post-surgical period has passed, is bypass vessel re-occlusion.

This has been a particular problem with bypass grafting of the left anterior descending coronary artery when the saphenous vein is employed.

Despite this finding, some cardiothoracic surgeons continue to utilize the saphenous vein because the internal thoracic artery is smaller in diameter and more fragile to manipulation; thus making the bypass more complex, time-consuming, and technically difficult.

Additionally, there are physiological characteristics of an artery (such as a tendency to constrict) which increases the risk of irreversible damage to the heart during the immediate period of post-surgical recovery.

There is a prolonged period during which trauma to the sternum (such as that caused by an automobile accident) can be especially dangerous.

The risk becomes even greater when the internal thoracic artery or arteries, which are principle suppliers of blood to the sternum, have been ligated and employed as bypass vessels.

Also, as they continue to rely on the use of the patient's vessels as bypass conduits, the procedures remain limited as to the number of bypasses which can be performed.

Because of these issues, these methods are not yet widely available.

Some less conventional techniques (such as those described above) are performed by only a limited number of appropriately skilled practitioners.

Finally, some techniques remain in the experimental stages, and are limited to animal testing.

Due to the limited number of arteries and / or veins available, standard procedures become increasingly risky to repeat.

A common problem with transplanted vessels is blood clotting, and agents which reduce such clotting have been widely reported.

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